Bernardes Marilia, Lo Presti Saberio, Ratzan Kenneth
Department of Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA.
Case Rep Infect Dis. 2018 Jun 26;2018:1247256. doi: 10.1155/2018/1247256. eCollection 2018.
We report a case of a 77-year-old woman who presented to the Emergency Room with a three-day history of oral lesions and jaw tightness. Her physical examination was remarkable for the presence of trismus and white ulcers on the visible portion of the tongue. CT head and neck was unremarkable, and she was discharged with empiric treatment for oral candidiasis. She returned two days later with worsening symptoms and subsequently developed tonic-clonic seizures. MRI of the brain and temporomandibular joints were noncontributory. Psychiatry was consulted, and the patient was prescribed olanzapine and mirtazapine for suspected depression with somatization symptoms. She continued to deteriorate despite therapy and developed right lid ptosis and ophthalmoparesis, which led to a presumptive diagnosis of cephalic tetanus. On the 14th day of illness, tetanus immune globulin, metronidazole, and tetanus toxoid vaccine were administered. Despite treatment, the patient died after 24 days of hospitalization. This case illustrates the importance of early recognition of tetanus since successful treatment depends on timely administration of immune globulin.
我们报告一例77岁女性患者，她因口腔病变和颌部紧绷感3天而就诊于急诊室。体格检查发现显著的牙关紧闭，且舌可见部分有白色溃疡。头颈部CT检查无异常，她接受了口腔念珠菌病的经验性治疗后出院。两天后她因症状加重返回，随后出现强直阵挛性发作。脑部和颞下颌关节的MRI检查无异常发现。咨询了精神科，患者因疑似伴有躯体化症状的抑郁症而被处方奥氮平和米氮平。尽管接受了治疗，她的病情仍持续恶化，并出现右侧眼睑下垂和眼球运动障碍，这导致初步诊断为头部破伤风。在患病第14天，给予破伤风免疫球蛋白、甲硝唑和破伤风类毒素疫苗。尽管进行了治疗，患者在住院24天后死亡。该病例说明了早期识别破伤风的重要性，因为成功治疗取决于免疫球蛋白的及时应用。
